<template>
  <el-dialog
    :close-on-click-modal="false"
    :title="title"
    :visible.sync="isShow"
    width="80%"
    @close="handleClose"
  >
    <table
      class="table_top"
      width="90%"
      align="center"
      cellpadding="0"
      cellspacing="0"
      border="0"
      style="font-size: 16px;"
    >
      <tbody style="font-size: 16px;">
        <tr style="font-size: 16px;">
          <td width="100px" class="font_weight" style="font-size: 16px;">
            家庭住址
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>

          <td width="100px" class="font_weight" style="font-size: 16px;">
            现住地址
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td width="135px" class="font_weight" style="font-size: 16px;">
            现住地址门牌号
            <font color="black" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td width="100px" class="font_weight" style="font-size: 16px;">
            建档时间
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td width="100px" class="font_weight" style="font-size: 16px;">
            户籍地址
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td width="135px" class="font_weight" style="font-size: 16px;">
            户籍地址门牌号
            <font color="black" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td class="font_weight" style="font-size: 16px;">
            建档机构
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td class="font_weight" style="font-size: 16px;">
            建档医生
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td class="font_weight" style="font-size: 16px;">
            责任医生
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td style="font-size: 16px;">家庭编号</td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td style="font-size: 16px;">
            录入人员
            <font color="black" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
          <td style="font-size: 16px;">管辖机构</td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td style="font-size: 16px;">
            录入时间
            <font color="black" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>

          <td style="font-size: 16px;">
            修改时间
            <font color="black" style="font-size: 16px;">*</font>
          </td>
          <td style="font-size: 16px;">
            <div style="font-size: 16px;">
              <input
                type="text"
                autocomplete="off"
                name=""
                class="x-form-text x-form-field x-trigger-noedit"
              />
            </div>
          </td>
        </tr>
      </tbody>
    </table>
    <h2 align="center" style="font-size: 16px;">
      <span class="STYLE1" style="font-size: 16px;">个人基本信息表</span>
    </h2>

    <table
      width="90%"
      align="center"
      style="margin-bottom:20px;font-size: 16px;"
      cellpadding="0"
      cellspacing="0"
    >
      <tbody style="font-size: 16px;">
        <tr height="25" style="font-size: 16px;">
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE1" style="font-size: 16px;"
              >姓名 <font color="red" style="font-size: 16px;">*</font> </span
            >：
          </td>
          <td colspan="2" align="left" style="font-size: 16px;">
            <input
              type="text"
              style="width:100%"
              autocomplete="off"
              name=""
              class=""
            />
          </td>
          <td
            colspan="1"
            align="center"
            class="STYLE1"
            style="font-size: 16px;"
          >
            居民健康档案号：
          </td>
          <td colspan="2" align="left" style="font-size: 16px;">
            <input
              type="text"
              style="width:100%"
              autocomplete="off"
              name=""
              class=""
            />
          </td>

          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE1" style="font-size: 16px;">医保号</span>
          </td>
          <td colspan="2" align="left" style="font-size: 16px;">
            <input
              type="text"
              style="width:100%"
              autocomplete="off"
              name=""
              class=""
            />
          </td>
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE1" style="font-size: 16px;">编号</span>：
          </td>
          <td colspan="2" style="font-size: 16px;">
            <input
              type="text"
              style="width:100%"
              autocomplete="off"
              name=""
              class=""
            />
          </td>
        </tr>
      </tbody>
    </table>
    <table
      width="90%"
      align="center"
      border="1"
      cellspacing="0"
      cellpadding="0"
      bordercolor="#000000"
      style="border-collapse: collapse; font-size: 16px;"
    >
      <tbody style="font-size: 16px;">
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >性别
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td height="30" colspan="4" style="font-size: 16px;">
            <!-- <span class="STYLE2" style="font-size: 16px;"> -->
            <input
              type="checkbox"
              name="hdsa0001.hdsa0001008"
              value="1"
              onclick=""
              style="font-size: 16px;"
            />
            <label class="checkboxLabel" style="font-size: 16px;">男</label>
            <input
              id="hdsa0001.hdsa0001008-2"
              type="checkbox"
              name="hdsa0001.hdsa0001008"
              value="2"
              checked="checked"
              onclick=""
              style="font-size: 16px;"
            />
            <label
              for="hdsa0001.hdsa0001008-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >女</label
            >
            <input
              id="hdsa0001.hdsa0001008-3"
              type="checkbox"
              name="hdsa0001.hdsa0001008"
              value="3"
              onclick="checkedThis(this,'hdsa0001.hdsa0001008','hdsa0001.hdsa0001008','hdsa0001.hdsa0001009')"
              disabled=""
              class="validate[required]"
              style="font-size: 16px;"
            />
            <label
              for="hdsa0001.hdsa0001008-3"
              class="checkboxLabel"
              style="font-size: 16px;"
              >未说明的性别</label
            >
            <input
              id="hdsa0001.hdsa0001008-4"
              type="checkbox"
              name="hdsa0001.hdsa0001008"
              value="0"
              onclick="checkedThis(this,'hdsa0001.hdsa0001008','hdsa0001.hdsa0001008','hdsa0001.hdsa0001009')"
              disabled=""
              class="validate[required]"
              style="font-size: 16px;"
            />
            <label
              for="hdsa0001.hdsa0001008-4"
              class="checkboxLabel"
              style="font-size: 16px;"
              >未知的性别</label
            >
            <!-- </span> -->
          </td>
          <td height="30" colspan="1" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >出生日期
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="2" style="font-size: 16px;">
            <el-date-picker
              v-model="birthdata"
              style="width:100%"
              type="date"
              placeholder="选择日期"
            >
            </el-date-picker>
          </td>
          <td colspan="1" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;">精准扶贫</span>
            <font color="red" style="font-size: 16px;">*</font>&nbsp;&nbsp;
            <input
              type="checkbox"
              name="hdsa0001.ispoor"
              value="0"
              checked="checked"
              onclick=""
              style="font-size: 16px;"
            />
            <label class="checkboxLabel" style="font-size: 16px;">否</label>
            <input
              id="hdsa0001.ispoor-2"
              type="checkbox"
              name="hdsa0001.ispoor"
              value="1"
              onclick=""
              style="font-size: 16px;"
            />
            <label
              for="hdsa0001.ispoor-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >是</label
            >
          </td>
          <td colspan="2" rowspan="4" align="center" style="font-size: 16px;">
            <div id="preview" title="点击上传照片" style="font-size: 16px;">
              <img
                src=""
                width="100"
                height="120"
                border="0"
                style="font-size: 16px;"
              />
            </div>
            <font color="red" style="font-size: 16px;">请选择登记照</font>
            <input
              id="upload"
              type="file"
              name="upload"
              size="1"
              value=""
              accept="image/bmp,image/png,image/gif,image/jpeg"
              title="照片上传"
              onchange=""
              style="font-size: 16px; width:100%"
            />
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;">身份证号</span>
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td colspan="4" style="font-size: 16px;">
            <input
              type="text"
              value=""
              name="hdsa0001.hdsa0001003"
              class="line "
              onblur=""
              style="font-size: 16px;width:100%"
            />
          </td>
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">工作单位</span>
          </td>
          <td colspan="3" style="font-size: 16px;">
            <input
              type="text"
              name="hdsa000101.hdsa000101004"
              size="40"
              maxlength="50"
              value=""
              class="line"
              style="font-size: 16px;width:100%"
            />
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;">本人电话</span>
            <font color="red" style="font-size: 16px;">*</font>
          </td>
          <td colspan="2" style="font-size: 16px;">
            <input
              id="hdsa0001029"
              type="text"
              name="hdsa0001.hdsa0001029"
              maxlength="20"
              value=""
              class="line"
              style="font-size: 16px;width:100%"
            />
          </td>
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">联系人姓名</span>
          </td>
          <td colspan="2" style="font-size: 16px;">
            <input
              id="hdsa0001048"
              type="text"
              name="hdsa0001.hdsa0001048"
              size="8"
              maxlength="20"
              value=""
              class="line"
              style="font-size: 16px;width:100%"
            />
          </td>
          <td colspan="1" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">联系人电话</span>
          </td>
          <td colspan="2" style="font-size: 16px;">
            <input
              id="hdsa0001049"
              type="text"
              name="hdsa0001.hdsa0001049"
              maxlength="20"
              value=""
              class="line"
              style="font-size: 16px;width:100%"
            />
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >常住类型
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="4" nowrap="" style="font-size: 16px;">
            &nbsp;
            <span class="STYLE2" style="font-size: 16px;">
              常住人口 (
              <input
                id="hdsa000101.hdsa000101008-1"
                type="checkbox"
                name="hdsa000101.hdsa000101008"
                value="0"
                checked="checked"
                onclick=""
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101008-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >户籍</label
              >
              <input
                id="hdsa000101.hdsa000101008-2"
                type="checkbox"
                name="hdsa000101.hdsa000101008"
                value="1"
                onclick=""
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101008-2"
                class="checkboxLabel"
                style="font-size: 16px;"
                >非户籍</label
              >

              )
              <input
                id="hdsa000101.hdsa000101008-1"
                type="checkbox"
                name="hdsa000101.hdsa000101008"
                value="2"
                onclick="checkedThis(this,'hdsa000101.hdsa000101008','hdsa000101.hdsa000101008','hdsa000101.hdsa000101009')"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101008-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >流动人口</label
              >
            </span>
          </td>
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >民族
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="3" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                id="hdsa000101.hdsa000101010-1"
                type="checkbox"
                name="hdsa000101.hdsa000101010"
                value="0"
                checked="checked"
                onclick=""
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101010-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >汉族</label
              >
              <input
                id="hdsa000101.hdsa000101010-2"
                type="checkbox"
                name="hdsa000101.hdsa000101010"
                value="1"
                onclick=""
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101010-2"
                class="checkboxLabel"
                style="font-size: 16px;"
                >少数民族</label
              >

              &nbsp;&nbsp;
              <input
                id="hdsa000101012"
                type="text"
                readonly="readonly"
                value=""
                onclick=""
                name="hdsa000101.hdsa000101012"
                cssclass="line"
                size="16"
                maxlength="20"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">血型</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <table style="font-size: 16px;">
              <tbody style="font-size: 16px;">
                <tr style="font-size: 16px;">
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      type="checkbox"
                      name="hdsa000101.hdsa000101013"
                      value="0"
                      id="hdsa000101.hdsa000101013-1"
                      onclick=""
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101013-1"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >A型</label
                    >
                    <input
                      type="checkbox"
                      name="hdsa000101.hdsa000101013"
                      value="1"
                      id="hdsa000101.hdsa000101013-2"
                      onclick=""
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101013-2"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >B型</label
                    >
                    <input
                      type="checkbox"
                      name="hdsa000101.hdsa000101013"
                      value="2"
                      id="hdsa000101.hdsa000101013-3"
                      onclick=""
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101013-3"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >O型</label
                    >
                    <input
                      type="checkbox"
                      name="hdsa000101.hdsa000101013"
                      value="3"
                      id="hdsa000101.hdsa000101013-4"
                      onclick=""
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101013-4"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >AB型</label
                    >
                    <input
                      type="checkbox"
                      name="hdsa000101.hdsa000101013"
                      value="4"
                      id="hdsa000101.hdsa000101013-5"
                      checked="checked"
                      onclick=""
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101013-5"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >不详</label
                    >
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    /RH：
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <label style="font-size: 16px;">
                      <input
                        type="hidden"
                        name="hdsa000101.hdsa000101016"
                        value="不详"
                        id="hdsa000101.hdsa000101016"
                        style="font-size: 16px;"
                      />

                      <input
                        type="checkbox"
                        name="hdsa000101.hdsa000101015"
                        value="0"
                        id="hdsa000101.hdsa000101015-1"
                        onclick=""
                        style="font-size: 16px;"
                      />
                      <label
                        for="hdsa000101.hdsa000101015-1"
                        class="checkboxLabel"
                        style="font-size: 16px;"
                        >阴性</label
                      >
                      <input
                        type="checkbox"
                        name="hdsa000101.hdsa000101015"
                        value="1"
                        id="hdsa000101.hdsa000101015-2"
                        onclick=""
                        style="font-size: 16px;"
                      />
                      <label
                        for="hdsa000101.hdsa000101015-2"
                        class="checkboxLabel"
                        style="font-size: 16px;"
                        >阳性</label
                      >
                      <input
                        type="checkbox"
                        name="hdsa000101.hdsa000101015"
                        value="2"
                        id="hdsa000101.hdsa000101015-3"
                        checked="checked"
                        onclick=""
                        style="font-size: 16px;"
                      />
                      <label
                        for="hdsa000101.hdsa000101015-3"
                        class="checkboxLabel"
                        style="font-size: 16px;"
                        >不详</label
                      >
                    </label>
                  </td>
                </tr>
              </tbody>
            </table>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >文化程度
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                type="hidden"
                name="hdsa000101.hdsa000101018"
                value="小学"
                id="hdsa000101.hdsa000101018"
                style="font-size: 16px;"
              />

              <input
                id="hdsa000101.hdsa000101017-1"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="0"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >研究生</label
              >
              <input
                id="hdsa000101.hdsa000101017-2"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="1"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-2"
                class="checkboxLabel"
                style="font-size: 16px;"
                >大学本科</label
              >
              <input
                id="hdsa000101.hdsa000101017-3"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="2"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-3"
                class="checkboxLabel"
                style="font-size: 16px;"
                >大学专科和专科学校</label
              >
              <input
                id="hdsa000101.hdsa000101017-4"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="3"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-4"
                class="checkboxLabel"
                style="font-size: 16px;"
                >中等专业学校</label
              >
              <input
                id="hdsa000101.hdsa000101017-5"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="4"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-5"
                class="checkboxLabel"
                style="font-size: 16px;"
                >技工学校</label
              >
              <input
                id="hdsa000101.hdsa000101017-6"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="5"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-6"
                class="checkboxLabel"
                style="font-size: 16px;"
                >高中</label
              >
              <input
                id="hdsa000101.hdsa000101017-7"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="6"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-7"
                class="checkboxLabel"
                style="font-size: 16px;"
                >初中</label
              >
              <input
                id="hdsa000101.hdsa000101017-8"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="7"
                checked="checked"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-8"
                class="checkboxLabel"
                style="font-size: 16px;"
                >小学</label
              >
              <input
                id="hdsa000101.hdsa000101017-9"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="8"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-9"
                class="checkboxLabel"
                style="font-size: 16px;"
                >文盲或半文盲</label
              >
              <input
                id="hdsa000101.hdsa000101017-10"
                type="checkbox"
                name="hdsa000101.hdsa000101017"
                value="9"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101017-10"
                class="checkboxLabel"
                style="font-size: 16px;"
                >不详</label
              >
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >职业
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                id="hdsa000101.hdsa000101020"
                type="hidden"
                name="hdsa000101.hdsa000101020"
                value="农、林、牧、渔、水利业生产人员          "
                style="font-size: 16px;"
              />

              <input
                id="hdsa000101.hdsa000101019-1"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="0"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-1"
                class="checkboxLabel"
                style="font-size: 16px;"
              >
                国家机关、党群组织、企业、事业单位负责人</label
              >
              <input
                id="hdsa000101.hdsa000101019-2"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="1"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-2"
                class="checkboxLabel"
                style="font-size: 16px;"
                >专业技术人员</label
              >
              <input
                id="hdsa000101.hdsa000101019-3"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="2"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-3"
                class="checkboxLabel"
                style="font-size: 16px;"
                >办事人员和有关人员</label
              >
              <input
                id="hdsa000101.hdsa000101019-4"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="3"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-4"
                class="checkboxLabel"
                style="font-size: 16px;"
                >商业、服务业人员</label
              >
              <input
                id="hdsa000101.hdsa000101019-5"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="4"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-5"
                class="checkboxLabel"
                style="font-size: 16px;"
                >农、林、牧、渔、水利业生产人员</label
              >
              <input
                id="hdsa000101.hdsa000101019-6"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="5"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-6"
                class="checkboxLabel"
                style="font-size: 16px;"
                >生产、运输设备操作人员及有关人员</label
              >
              <input
                id="hdsa000101.hdsa000101019-7"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="6"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-7"
                class="checkboxLabel"
                style="font-size: 16px;"
                >军人</label
              >
              <input
                id="hdsa000101.hdsa000101019-8"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="7"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-8"
                class="checkboxLabel"
                style="font-size: 16px;"
                >不便分类的其他从业人员</label
              >
              <input
                id="hdsa000101.hdsa000101019-9"
                type="checkbox"
                name="hdsa000101.hdsa000101019"
                value="8"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101019-9"
                class="checkboxLabel"
                style="font-size: 16px;"
                >无职业</label
              >
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >婚姻状况
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                id="hdsa000101.hdsa000101022"
                type="hidden"
                name="hdsa000101.hdsa000101022"
                value="已婚"
                style="font-size: 16px;"
              />

              <input
                id="hdsa000101.hdsa000101021-1"
                type="checkbox"
                name="hdsa000101.hdsa000101021"
                value="0"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101021-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >未婚</label
              >
              <input
                id="hdsa000101.hdsa000101021-2"
                type="checkbox"
                name="hdsa000101.hdsa000101021"
                value="1"
                checked="checked"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101021-2"
                class="checkboxLabel"
                style="font-size: 16px;"
              >
                已婚</label
              >
              <input
                id="hdsa000101.hdsa000101021-3"
                type="checkbox"
                name="hdsa000101.hdsa000101021"
                value="2"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101021-3"
                class="checkboxLabel"
                style="font-size: 16px;"
                >丧偶</label
              >
              <input
                id="hdsa000101.hdsa000101021-4"
                type="checkbox"
                name="hdsa000101.hdsa000101021"
                value="3"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101021-4"
                class="checkboxLabel"
                style="font-size: 16px;"
                >离婚</label
              >
              <input
                id="hdsa000101.hdsa000101021-5"
                type="checkbox"
                name="hdsa000101.hdsa000101021"
                value="4"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101021-5"
                class="checkboxLabel"
                style="font-size: 16px;"
                >未说明的婚姻状况</label
              >
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="52" colspan="2" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;"
              >医疗费用 支付方式
            </span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                id="yl_1"
                type="checkbox"
                name="hdsa000101.payWaylist[0].hdsa00010101002"
                value="0,城镇职工基本医疗保险"
                style="font-size: 16px;"
              />
              城镇职工基本医疗保险

              <input
                id="yl_2"
                type="checkbox"
                name="hdsa000101.payWaylist[1].hdsa00010101002"
                value="1,城镇居民基本医疗保险"
                style="font-size: 16px;"
              />
              城镇居民基本医疗保险

              <input
                id="yl_3"
                type="checkbox"
                name="hdsa000101.payWaylist[2].hdsa00010101002"
                checked=""
                value="2,新型农村合作医疗"
                style="font-size: 16px;"
              />
              新型农村合作医疗

              <input
                id="yl_4"
                type="checkbox"
                name="hdsa000101.payWaylist[3].hdsa00010101002"
                value="3,贫困救助"
                style="font-size: 16px;"
              />
              贫困救助

              <input
                id="yl_5"
                type="checkbox"
                name="hdsa000101.payWaylist[4].hdsa00010101002"
                value="4,商业医疗保险"
                style="font-size: 16px;"
              />
              商业医疗保险

              <input
                id="yl_6"
                type="checkbox"
                name="hdsa000101.payWaylist[5].hdsa00010101002"
                value="5,全公费"
                style="font-size: 16px;"
              />
              全公费

              <input
                id="yl_7"
                type="checkbox"
                name="hdsa000101.payWaylist[6].hdsa00010101002"
                value="6,全自费"
                style="font-size: 16px;"
              />
              全自费
              <br style="font-size: 16px;" />
              <input
                id="yl_8"
                type="checkbox"
                name="hdsa000101.payWaylist[7].hdsa00010101002"
                value="7,其他"
                style="font-size: 16px;"
              />
              其他

              <input
                id="hdsa000101hdsa000101023"
                type="text"
                readonly="readonly"
                value=""
                name="hdsa000101.hdsa000101023"
                cssclass="line"
                size="12"
                maxlength="50"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>

        <tr style="font-size: 16px;">
          <td height="39" colspan="2" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">药物过敏史</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span id="ywgms" class="STYLE2" style="font-size: 16px;">
              <input
                id="hdsa000101.hdsa000101024-1"
                type="checkbox"
                name="hdsa000101.hdsa000101024"
                value="0"
                checked="checked"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101024-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >无</label
              >

              <input
                id="QMS"
                type="checkbox"
                name="hdsa000101.allergenslist[0].hdsa00010102002"
                value="0,青霉素"
                style="font-size: 16px;"
              />
              青霉素
              <input
                id="HA"
                type="checkbox"
                name="hdsa000101.allergenslist[1].hdsa00010102002"
                value="1,磺胺"
                style="font-size: 16px;"
              />
              磺胺
              <input
                id="LMS"
                type="checkbox"
                name="hdsa000101.allergenslist[2].hdsa00010102002"
                value="2,链霉素"
                style="font-size: 16px;"
              />
              链霉素
              <input
                id="QT"
                type="checkbox"
                name="hdsa000101.allergenslist[3].hdsa00010102002"
                value="3,其他 "
                style="font-size: 16px;"
              />
              其他
              <input
                id="hdsa000101hdsa000101026"
                type="text"
                readonly="readonly"
                value=""
                name="hdsa000101.hdsa000101026"
                cssclass="line"
                size="12"
                maxlength="50"
                style="font-size: 16px;"
              />
              <input
                id="hdsa000101.hdsa000101025"
                type="hidden"
                name="hdsa000101.hdsa000101025"
                value=""
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">暴露史</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span id="bls" class="STYLE2" style="font-size: 16px;">
              <input
                id="hdsa000101.hdsa000101036-1"
                type="checkbox"
                name="hdsa000101.hdsa000101036"
                value="0"
                checked="checked"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101036-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >无</label
              >

              <input
                id="gm_2"
                type="checkbox"
                name="hdsa000101.envrisklist[0].hdsa00010109002"
                value="0,化学品"
                style="font-size: 16px;"
              />
              化学品
              <input
                id="gm_3"
                type="checkbox"
                name="hdsa000101.envrisklist[1].hdsa00010109002"
                value="1,毒物"
                style="font-size: 16px;"
              />
              毒物
              <input
                id="gm_4"
                type="checkbox"
                name="hdsa000101.envrisklist[2].hdsa00010109002"
                value="2,射线"
                style="font-size: 16px;"
              />
              射线
            </span>
            <input
              id="hdsa000101.hdsa000101037"
              type="hidden"
              name="hdsa000101.hdsa000101037"
              value=""
              style="font-size: 16px;"
            />
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td width="42" rowspan="4" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">既往史</span>
          </td>
          <td align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">疾病</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <table id="jws_jb" width="100%" style="font-size: 16px;">
              <tbody style="font-size: 16px;">
                <tr style="font-size: 16px;">
                  <td width="33%" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="hdsa000101.hdsa000101039"
                      type="hidden"
                      name="hdsa000101.hdsa000101039"
                      value=""
                      style="font-size: 16px;"
                    />

                    <input
                      id="hdsa000101.hdsa000101038-1"
                      type="checkbox"
                      name="hdsa000101.hdsa000101038"
                      value="99"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101038-1"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >无</label
                    >
                  </td>
                  <td width="33%" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_2"
                      type="checkbox"
                      name="hdsa000101.diseasehistorylist[0].hdsa00010108002"
                      value="0,高血压"
                      style="font-size: 16px;"
                    />
                    高血压 确诊时间：
                    <input
                      id="jwsjb1"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[0].hdsa00010108004"
                      size="12"
                      title="时间格式:YYYY-MM"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td width="33%" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_3"
                      type="checkbox"
                      name="hdsa000101.diseasehistorylist[1].hdsa00010108002"
                      value="1,糖尿病"
                      style="font-size: 16px;"
                    />
                    糖尿病 确诊时间：
                    <input
                      id="jwsjb2"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[1].hdsa00010108004"
                      size="12"
                      title="时间格式:YYYY-MM"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_4"
                      type="checkbox"
                      value="2,冠心病"
                      name="hdsa000101.diseasehistorylist[2].hdsa00010108002"
                      style="font-size: 16px;"
                    />冠心病 确诊时间：
                    <input
                      id="jwsjb3"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[2].hdsa00010108004"
                      size="12"
                      maxlength="7"
                      title="时间格式:YYYY-MM"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_5"
                      type="checkbox"
                      value="3,慢性阻塞性肺疾病"
                      name="hdsa000101.diseasehistorylist[3].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    慢性阻塞性肺疾病 确诊时间：
                    <input
                      id="jwsjb4"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[3].hdsa00010108004"
                      size="12"
                      title="时间格式:YYYY-MM"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_6"
                      type="checkbox"
                      value="4,恶性肿瘤"
                      name="hdsa000101.diseasehistorylist[4].hdsa00010108002"
                      style="font-size: 16px;"
                    />恶性肿瘤 确诊时间：
                    <input
                      id="jwsjb5"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[4].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_7"
                      type="checkbox"
                      value="5,脑卒中"
                      name="hdsa000101.diseasehistorylist[5].hdsa00010108002"
                      style="font-size: 16px;"
                    />脑卒中 确诊时间：
                    <input
                      id="jwsjb6"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[5].hdsa00010108004"
                      size="12"
                      maxlength="7"
                      title="时间格式:YYYY-MM"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_8"
                      type="checkbox"
                      value="6,重性精神疾病 "
                      name="hdsa000101.diseasehistorylist[6].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    严重精神障碍 确诊时间：
                    <input
                      id="jwsjb7"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[6].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_9"
                      type="checkbox"
                      value="7,结核病"
                      name="hdsa000101.diseasehistorylist[7].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    结核病 确诊时间：
                    <input
                      id="jwsjb8"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[7].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_10"
                      type="checkbox"
                      value="8,肝炎"
                      name="hdsa000101.diseasehistorylist[8].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    肝炎 确诊时间：
                    <input
                      id="jwsjb9"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[8].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_11"
                      type="checkbox"
                      value="9,其他法定传染病"
                      name="hdsa000101.diseasehistorylist[9].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    其他法定传染病 确诊时间：
                    <input
                      id="jwsjb10"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[9].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                  <td class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_12"
                      type="checkbox"
                      value="10,职业病"
                      name="hdsa000101.diseasehistorylist[10].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    职业病 确诊时间：
                    <input
                      id="jwsjb11"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[10].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td colspan="3" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="jb_13"
                      type="checkbox"
                      value="11,其他"
                      name="hdsa000101.diseasehistorylist[11].hdsa00010108002"
                      style="font-size: 16px;"
                    />
                    其他

                    <input
                      id="hdsa000101hdsa000101040"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.hdsa000101040"
                      cssclass="line"
                      size="20"
                      style="font-size: 16px;"
                    />
                    确诊时间：
                    <input
                      id="jwsjb12"
                      type="text"
                      readonly="readonly"
                      value=""
                      name="hdsa000101.diseasehistorylist[11].hdsa00010108004"
                      title="时间格式:YYYY-MM"
                      size="12"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                  </td>
                </tr>
              </tbody>
            </table>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td width="68" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">手术</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <table
              id="shoushutable"
              border="1"
              width="90%"
              style="font-size: 16px;"
            >
              <tbody style="font-size: 16px;">
                <tr style="font-size: 16px;">
                  <td colspan="3" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="hdsa000101.hdsa000101027-1"
                      type="checkbox"
                      name="hdsa000101.hdsa000101027"
                      value="0"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101027-1"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >无</label
                    >
                    <input
                      id="hdsa000101.hdsa000101027-2"
                      type="checkbox"
                      name="hdsa000101.hdsa000101027"
                      value="1"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101027-2"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                    >
                      有：</label
                    >

                    名称：
                    <input
                      id="hdsa00010104002"
                      readonly="readonly"
                      name="hdsa000101.operationName"
                      type="text"
                      class="line"
                      style="font-size: 16px;"
                    />
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 手术时间：
                    <input
                      id="hdsa00010104004"
                      readonly="readonly"
                      name="hdsa000101.operationDtime"
                      title="时间格式:YYYY-MM"
                      type="text"
                      maxlength="7"
                      style="font-size: 16px;"
                    />
                    &nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;
                    <input
                      id="button1"
                      name="button1"
                      type="button"
                      class="button blue small"
                      value="添加"
                      style="font-size: 16px;"
                    />
                    <font color="red" style="font-size: 16px;"
                      >录入信息后需点击添加！</font
                    >
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td
                    width="50%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    名称
                  </td>
                  <td
                    width="25%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    手术时间
                  </td>
                  <td
                    width="20%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    操作
                  </td>
                </tr>
              </tbody>
            </table>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td width="68" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">外伤</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <table id="wstable" border="1" width="90%" style="font-size: 16px;">
              <tbody style="font-size: 16px;">
                <tr style="font-size: 16px;">
                  <td colspan="3" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="hdsa000101.hdsa000101031"
                      type="hidden"
                      name="hdsa000101.hdsa000101031"
                      value=""
                      style="font-size: 16px;"
                    />

                    <input
                      id="hdsa000101.hdsa000101030-1"
                      type="checkbox"
                      name="hdsa000101.hdsa000101030"
                      value="0"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101030-1"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >无</label
                    >
                    <input
                      id="hdsa000101.hdsa000101030-2"
                      type="checkbox"
                      name="hdsa000101.hdsa000101030"
                      value="1"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101030-2"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                    >
                      有：</label
                    >

                    名称：
                    <input
                      id="hdsa00010105002"
                      readonly="readonly"
                      name="hdsa000101.hdsa00010105002"
                      type="text"
                      class="line"
                      style="font-size: 16px;"
                    />
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 外伤时间：
                    <input
                      id="hdsa00010105003"
                      readonly="readonly"
                      name="hdsa000101.hdsa00010105003"
                      title="时间格式:YYYY-MM"
                      type="text"
                      maxlength="7"
                      onblur="dateValidation('hdsa00010105003')"
                      style="font-size: 16px;"
                    />
                    &nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;
                    <input
                      id="button2"
                      name="add"
                      type="button"
                      value="添加"
                      class="button blue small"
                      style="font-size: 16px;"
                    />
                    <font color="red" style="font-size: 16px;">同上！</font>
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td
                    width="50%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    名称
                  </td>
                  <td
                    width="25%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    外伤时间
                  </td>
                  <td
                    width="20%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    操作
                  </td>
                </tr>
              </tbody>
            </table>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td width="68" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">输血</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <table id="sxtable" border="1" width="90%" style="font-size: 16px;">
              <tbody style="font-size: 16px;">
                <tr style="font-size: 16px;">
                  <td colspan="3" class="STYLE2" style="font-size: 16px;">
                    <input
                      id="hdsa000101.hdsa000101034"
                      type="hidden"
                      name="hdsa000101.hdsa000101034"
                      value=""
                      style="font-size: 16px;"
                    />

                    <input
                      id="hdsa000101.hdsa000101033-1"
                      type="checkbox"
                      name="hdsa000101.hdsa000101033"
                      value="0"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101033-1"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                      >无</label
                    >
                    <input
                      id="hdsa000101.hdsa000101033-2"
                      type="checkbox"
                      name="hdsa000101.hdsa000101033"
                      value="1"
                      style="font-size: 16px;"
                    />
                    <label
                      for="hdsa000101.hdsa000101033-2"
                      class="checkboxLabel"
                      style="font-size: 16px;"
                    >
                      有：</label
                    >

                    原因：
                    <input
                      id="hdsa00010103004"
                      readonly="readonly"
                      name="hdsa000101.bloodTypeName"
                      type="text"
                      class="line"
                      style="font-size: 16px;"
                    />
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 输血时间：
                    <input
                      id="hdsa00010103006"
                      readonly="readonly"
                      name="hdsa000101.bloodTransfDTime"
                      title="时间格式:YYYY-MM"
                      type="text"
                      maxlength="7"
                      class="line validate[custom[dateyymm]] text-input"
                      style="font-size: 16px;"
                    />
                    &nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;
                    <input
                      id="button3"
                      name="add"
                      type="button"
                      value="添加"
                      class="button blue small"
                      style="font-size: 16px;"
                    />
                    <font color="red" style="font-size: 16px;">同上！</font>
                  </td>
                </tr>
                <tr style="font-size: 16px;">
                  <td
                    width="50%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    原因
                  </td>
                  <td
                    width="25%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    输血时间
                  </td>
                  <td
                    width="20%"
                    align="center"
                    class="STYLE2"
                    style="font-size: 16px;"
                  >
                    操作
                  </td>
                </tr>
              </tbody>
            </table>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td colspan="2" rowspan="4" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">家族史</span>
          </td>
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">父亲</span>
          </td>
          <td colspan="9" align="left" style="font-size: 16px;">
            <span id="jzs_fq" class="STYLE2" style="font-size: 16px;">
              <input
                id="fq1"
                type="checkbox"
                value="11,无"
                name="hdsa000101.famhistorylist1[11].hdsa00010107002"
                style="font-size: 16px;"
              />
              无
              <input
                id="form1_hdsa000101_famhistorylist1_11__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[11].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_11__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[11].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq2"
                type="checkbox"
                value="0,高血压"
                name="hdsa000101.famhistorylist1[0].hdsa00010107002"
                style="font-size: 16px;"
              />
              高血压
              <input
                id="form1_hdsa000101_famhistorylist1_0__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[0].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_0__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[0].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq3"
                type="checkbox"
                value="1,糖尿病"
                name="hdsa000101.famhistorylist1[1].hdsa00010107002"
                style="font-size: 16px;"
              />
              糖尿病
              <input
                id="form1_hdsa000101_famhistorylist1_1__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[1].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_1__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[1].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq4"
                type="checkbox"
                value="2,冠心病"
                name="hdsa000101.famhistorylist1[2].hdsa00010107002"
                style="font-size: 16px;"
              />
              冠心病
              <input
                id="form1_hdsa000101_famhistorylist1_2__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[2].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_2__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[2].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq5"
                type="checkbox"
                value="3,慢性阻塞性肺疾病"
                name="hdsa000101.famhistorylist1[3].hdsa00010107002"
                style="font-size: 16px;"
              />
              慢性阻塞性肺疾病
              <input
                id="form1_hdsa000101_famhistorylist1_3__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[3].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_3__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[3].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq6"
                type="checkbox"
                value="4,恶性肿瘤"
                name="hdsa000101.famhistorylist1[4].hdsa00010107002"
                style="font-size: 16px;"
              />
              恶性肿瘤
              <input
                id="form1_hdsa000101_famhistorylist1_4__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[4].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_4__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[4].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq7"
                type="checkbox"
                value="5,脑卒中"
                name="hdsa000101.famhistorylist1[5].hdsa00010107002"
                style="font-size: 16px;"
              />
              脑卒中
              <input
                id="form1_hdsa000101_famhistorylist1_5__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[5].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_5__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[5].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq8"
                type="checkbox"
                value="6,重性精神疾病"
                name="hdsa000101.famhistorylist1[6].hdsa00010107002"
                style="font-size: 16px;"
              />
              严重精神障碍
              <input
                id="form1_hdsa000101_famhistorylist1_6__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[6].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_6__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[6].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq9"
                type="checkbox"
                value="7,结核病"
                name="hdsa000101.famhistorylist1[7].hdsa00010107002"
                style="font-size: 16px;"
              />
              结核病
              <input
                id="form1_hdsa000101_famhistorylist1_7__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[7].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_7__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[7].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq10"
                type="checkbox"
                value="8,肝炎"
                name="hdsa000101.famhistorylist1[8].hdsa00010107002"
                style="font-size: 16px;"
              />
              肝炎
              <input
                id="form1_hdsa000101_famhistorylist1_8__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[8].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_8__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[8].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq11"
                type="checkbox"
                value="9,先天畸形"
                name="hdsa000101.famhistorylist1[9].hdsa00010107002"
                style="font-size: 16px;"
              />
              先天畸形
              <input
                id="form1_hdsa000101_famhistorylist1_9__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[9].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_9__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[9].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />

              <input
                id="fq12"
                type="checkbox"
                value="10,其他"
                name="hdsa000101.famhistorylist1[10].hdsa00010107002"
                style="font-size: 16px;"
              />
              其他
              <input
                id="hdsa000101hdsa00010107006"
                type="text"
                readonly="readonly"
                value=""
                name="hdsa000101.famhistorylist1[10].hdsa00010107006"
                cssclass="line"
                size="13"
                maxlength="50"
                style="font-size: 16px;"
              />
              <input
                id="form1_hdsa000101_famhistorylist1_10__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist1[10].hdsa00010107004"
                value="0"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist1_10__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist1[10].hdsa00010107005"
                value="父亲"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr colspan="1" style="font-size: 16px;">
          <td align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">母亲</span>
          </td>
          <td colspan="9" align="left" style="font-size: 16px;">
            <span id="jzs_mq" class="STYLE2" style="font-size: 16px;">
              <input
                id="mq1"
                type="checkbox"
                value="11,无"
                name="hdsa000101.famhistorylist2[11].hdsa00010107002"
                style="font-size: 16px;"
              />
              无
              <input
                id="form1_hdsa000101_famhistorylist2_11__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[11].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_11__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[11].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq2"
                type="checkbox"
                value="0,高血压"
                name="hdsa000101.famhistorylist2[0].hdsa00010107002"
                style="font-size: 16px;"
              />
              高血压
              <input
                id="form1_hdsa000101_famhistorylist2_0__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[0].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_0__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[0].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq3"
                type="checkbox"
                value="1,糖尿病"
                name="hdsa000101.famhistorylist2[1].hdsa00010107002"
                style="font-size: 16px;"
              />
              糖尿病
              <input
                id="form1_hdsa000101_famhistorylist2_1__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[1].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_1__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[1].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq4"
                type="checkbox"
                value="2,冠心病"
                name="hdsa000101.famhistorylist2[2].hdsa00010107002"
                style="font-size: 16px;"
              />
              冠心病
              <input
                id="form1_hdsa000101_famhistorylist2_2__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[2].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_2__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[2].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq5"
                type="checkbox"
                value="3,慢性阻塞性肺疾病"
                name="hdsa000101.famhistorylist2[3].hdsa00010107002"
                style="font-size: 16px;"
              />
              慢性阻塞性肺疾病
              <input
                id="form1_hdsa000101_famhistorylist2_3__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[3].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_3__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[3].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq6"
                type="checkbox"
                value="4,恶性肿瘤"
                name="hdsa000101.famhistorylist2[4].hdsa00010107002"
                style="font-size: 16px;"
              />
              恶性肿瘤
              <input
                id="form1_hdsa000101_famhistorylist2_4__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[4].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_4__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[4].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq7"
                type="checkbox"
                value="5,脑卒中"
                name="hdsa000101.famhistorylist2[5].hdsa00010107002"
                style="font-size: 16px;"
              />
              脑卒中
              <input
                id="form1_hdsa000101_famhistorylist2_5__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[5].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_5__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[5].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq8"
                type="checkbox"
                value="6,重性精神疾病"
                name="hdsa000101.famhistorylist2[6].hdsa00010107002"
                style="font-size: 16px;"
              />
              严重精神障碍
              <input
                id="form1_hdsa000101_famhistorylist2_6__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[6].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_6__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[6].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq9"
                type="checkbox"
                value="7,结核病"
                name="hdsa000101.famhistorylist2[7].hdsa00010107002"
                style="font-size: 16px;"
              />
              结核病
              <input
                id="form1_hdsa000101_famhistorylist2_7__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[7].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_7__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[7].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq10"
                type="checkbox"
                value="8,肝炎"
                name="hdsa000101.famhistorylist2[8].hdsa00010107002"
                style="font-size: 16px;"
              />
              肝炎
              <input
                id="form1_hdsa000101_famhistorylist2_8__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[8].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_8__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[8].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq11"
                type="checkbox"
                value="9,先天畸形"
                name="hdsa000101.famhistorylist2[9].hdsa00010107002"
                style="font-size: 16px;"
              />
              先天畸形
              <input
                id="form1_hdsa000101_famhistorylist2_9__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[9].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_9__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[9].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />

              <input
                id="mq12"
                type="checkbox"
                value="10,其他"
                name="hdsa000101.famhistorylist2[10].hdsa00010107002"
                style="font-size: 16px;"
              />
              其他
              <input
                id="hdsa000101hdsa00010107006m"
                type="text"
                value=""
                name="hdsa000101.famhistorylist2[10].hdsa00010107006"
                cssclass="line"
                size="13"
                maxlength="50"
                style="font-size: 16px;"
              />
              <input
                id="form1_hdsa000101_famhistorylist2_10__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist2[10].hdsa00010107004"
                value="1"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist2_10__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist2[10].hdsa00010107005"
                value="母亲"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td colspan="1" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">兄弟姐妹</span>
          </td>
          <td colspan="9" style="font-size: 16px;">
            <span id="jzs_xm" class="STYLE2" style="font-size: 16px;">
              <input
                id="xm1"
                type="checkbox"
                value="11,无"
                name="hdsa000101.famhistorylist3[11].hdsa00010107002"
                style="font-size: 16px;"
              />
              无
              <input
                id="form1_hdsa000101_famhistorylist3_11__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[11].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_11__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[11].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm2"
                type="checkbox"
                value="0,高血压"
                name="hdsa000101.famhistorylist3[0].hdsa00010107002"
                style="font-size: 16px;"
              />
              高血压
              <input
                id="form1_hdsa000101_famhistorylist3_0__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[0].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_0__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[0].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm3"
                type="checkbox"
                value="1,糖尿病"
                name="hdsa000101.famhistorylist3[1].hdsa00010107002"
                style="font-size: 16px;"
              />
              糖尿病
              <input
                id="form1_hdsa000101_famhistorylist3_1__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[1].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_1__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[1].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm4"
                type="checkbox"
                value="2,冠心病"
                name="hdsa000101.famhistorylist3[2].hdsa00010107002"
                style="font-size: 16px;"
              />
              冠心病
              <input
                id="form1_hdsa000101_famhistorylist3_2__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[2].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_2__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[2].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm5"
                type="checkbox"
                value="3,慢性阻塞性肺疾病"
                name="hdsa000101.famhistorylist3[3].hdsa00010107002"
                style="font-size: 16px;"
              />
              慢性阻塞性肺疾病
              <input
                id="form1_hdsa000101_famhistorylist3_3__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[3].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_3__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[3].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm6"
                type="checkbox"
                value="4,恶性肿瘤"
                name="hdsa000101.famhistorylist3[4].hdsa00010107002"
                style="font-size: 16px;"
              />
              恶性肿瘤
              <input
                id="form1_hdsa000101_famhistorylist3_4__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[4].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_4__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[4].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm7"
                type="checkbox"
                value="5,脑卒中"
                name="hdsa000101.famhistorylist3[5].hdsa00010107002"
                style="font-size: 16px;"
              />
              脑卒中
              <input
                id="form1_hdsa000101_famhistorylist3_5__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[5].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_5__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[5].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm8"
                type="checkbox"
                value="6,重性精神疾病"
                name="hdsa000101.famhistorylist3[6].hdsa00010107002"
                style="font-size: 16px;"
              />
              严重精神障碍
              <input
                id="form1_hdsa000101_famhistorylist3_6__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[6].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_6__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[6].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm9"
                type="checkbox"
                value="7,结核病"
                name="hdsa000101.famhistorylist3[7].hdsa00010107002"
                style="font-size: 16px;"
              />
              结核病
              <input
                id="form1_hdsa000101_famhistorylist3_7__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[7].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_7__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[7].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm10"
                type="checkbox"
                value="8,肝炎"
                name="hdsa000101.famhistorylist3[8].hdsa00010107002"
                style="font-size: 16px;"
              />
              肝炎
              <input
                id="form1_hdsa000101_famhistorylist3_8__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[8].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_8__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[8].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm11"
                type="checkbox"
                value="9,先天畸形"
                name="hdsa000101.famhistorylist3[9].hdsa00010107002"
                style="font-size: 16px;"
              />
              先天畸形
              <input
                id="form1_hdsa000101_famhistorylist3_9__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[9].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_9__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[9].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />

              <input
                id="xm12"
                type="checkbox"
                value="10,其他"
                name="hdsa000101.famhistorylist3[10].hdsa00010107002"
                style="font-size: 16px;"
              />
              其他
              <input
                id="hdsa000101hdsa00010107006x"
                type="text"
                readonly="readonly"
                value=""
                name="hdsa000101.famhistorylist3[10].hdsa00010107006"
                cssclass="line"
                size="13"
                maxlength="50"
                style="font-size: 16px;"
              />
              <input
                id="form1_hdsa000101_famhistorylist3_10__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist3[10].hdsa00010107004"
                value="2"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist3_10__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist3[10].hdsa00010107005"
                value="兄弟姐妹"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td colspan="1" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">子女</span>
          </td>
          <td colspan="9" style="font-size: 16px;">
            <span id="jzs_zn" class="STYLE2" style="font-size: 16px;">
              <input
                id="zn1"
                type="checkbox"
                value="11,无"
                name="hdsa000101.famhistorylist4[11].hdsa00010107002"
                style="font-size: 16px;"
              />
              无
              <input
                id="form1_hdsa000101_famhistorylist4_11__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[11].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_11__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[11].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn2"
                type="checkbox"
                value="0,高血压"
                name="hdsa000101.famhistorylist4[0].hdsa00010107002"
                style="font-size: 16px;"
              />
              高血压
              <input
                id="form1_hdsa000101_famhistorylist4_0__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[0].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_0__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[0].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn3"
                onclick="checkBoxChecd2('jzs_zn','1','hdsa000101hdsa00010107006z','','zn12')"
                type="checkbox"
                value="1,糖尿病"
                name="hdsa000101.famhistorylist4[1].hdsa00010107002"
                style="font-size: 16px;"
              />
              糖尿病
              <input
                id="form1_hdsa000101_famhistorylist4_1__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[1].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_1__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[1].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn4"
                type="checkbox"
                value="2,冠心病"
                name="hdsa000101.famhistorylist4[2].hdsa00010107002"
                style="font-size: 16px;"
              />
              冠心病
              <input
                id="form1_hdsa000101_famhistorylist4_2__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[2].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_2__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[2].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn5"
                type="checkbox"
                value="3,慢性阻塞性肺疾病"
                name="hdsa000101.famhistorylist4[3].hdsa00010107002"
                style="font-size: 16px;"
              />
              慢性阻塞性肺疾病
              <input
                id="form1_hdsa000101_famhistorylist4_3__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[3].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_3__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[3].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn6"
                type="checkbox"
                value="4,恶性肿瘤"
                name="hdsa000101.famhistorylist4[4].hdsa00010107002"
                style="font-size: 16px;"
              />
              恶性肿瘤
              <input
                id="form1_hdsa000101_famhistorylist4_4__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[4].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_4__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[4].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn7"
                type="checkbox"
                value="5,脑卒中"
                name="hdsa000101.famhistorylist4[5].hdsa00010107002"
                style="font-size: 16px;"
              />
              脑卒中
              <input
                id="form1_hdsa000101_famhistorylist4_5__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[5].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_5__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[5].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn8"
                type="checkbox"
                value="6,重性精神疾病"
                name="hdsa000101.famhistorylist4[6].hdsa00010107002"
                style="font-size: 16px;"
              />
              严重精神障碍
              <input
                id="form1_hdsa000101_famhistorylist4_6__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[6].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_6__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[6].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn9"
                type="checkbox"
                value="7,结核病"
                name="hdsa000101.famhistorylist4[7].hdsa00010107002"
                style="font-size: 16px;"
              />
              结核病
              <input
                id="form1_hdsa000101_famhistorylist4_7__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[7].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_7__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[7].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn10"
                type="checkbox"
                value="8,肝炎"
                name="hdsa000101.famhistorylist4[8].hdsa00010107002"
                style="font-size: 16px;"
              />
              肝炎
              <input
                id="form1_hdsa000101_famhistorylist4_8__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[8].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_8__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[8].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn11"
                type="checkbox"
                value="9,先天畸形"
                name="hdsa000101.famhistorylist4[9].hdsa00010107002"
                style="font-size: 16px;"
              />
              先天畸形
              <input
                id="form1_hdsa000101_famhistorylist4_9__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[9].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_9__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[9].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />

              <input
                id="zn12"
                type="checkbox"
                value="10,其他"
                name="hdsa000101.famhistorylist4[10].hdsa00010107002"
                style="font-size: 16px;"
              />
              其他
              <input
                id="hdsa000101hdsa00010107006z"
                type="text"
                value=""
                name="hdsa000101.famhistorylist4[10].hdsa00010107006"
                cssclass="line"
                size="13"
                maxlength="50"
                style="font-size: 16px;"
              />
              <input
                id="form1_hdsa000101_famhistorylist4_10__hdsa00010107004"
                type="hidden"
                name="hdsa000101.famhistorylist4[10].hdsa00010107004"
                value="3"
                style="font-size: 16px;"
              />

              <input
                id="form1_hdsa000101_famhistorylist4_10__hdsa00010107005"
                type="hidden"
                name="hdsa000101.famhistorylist4[10].hdsa00010107005"
                value="子女"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">遗传病史</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                id="hdsa000101042"
                type="hidden"
                name="hdsa000101.hdsa000101042"
                value="无"
                style="font-size: 16px;"
              />

              <input
                id="hdsa000101.hdsa000101041-1"
                type="checkbox"
                name="hdsa000101.hdsa000101041"
                value="0"
                checked="checked"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101041-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >无</label
              >
              <input
                id="hdsa000101.hdsa000101041-2"
                type="checkbox"
                name="hdsa000101.hdsa000101041"
                value="1"
                style="font-size: 16px;"
              />
              <label
                for="hdsa000101.hdsa000101041-2"
                class="checkboxLabel"
                style="font-size: 16px;"
                >有</label
              >

              :疾病名称
              <input
                id="hdsa000101043"
                type="text"
                name="hdsa000101.hdsa000101043"
                readonly="readonly"
                class="line"
                maxlength="50"
                value=""
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td height="30" colspan="2" align="center" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">残疾情况</span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span id="cjqk" class="STYLE2" style="font-size: 16px;">
              <input
                id="cj1"
                type="checkbox"
                value="0,无残疾"
                name="hdsa000101.disabilitylist[0].hdsa00010106002"
                style="font-size: 16px;"
              />
              无残疾
              <input
                id="cj2"
                type="checkbox"
                value="1,视力残疾"
                name="hdsa000101.disabilitylist[1].hdsa00010106002"
                style="font-size: 16px;"
              />
              视力残疾
              <input
                id="cj3"
                type="checkbox"
                value="2,听力残疾"
                name="hdsa000101.disabilitylist[2].hdsa00010106002"
                style="font-size: 16px;"
              />
              听力残疾
              <input
                id="cj4"
                type="checkbox"
                value="3,言语残疾"
                name="hdsa000101.disabilitylist[3].hdsa00010106002"
                style="font-size: 16px;"
              />
              言语残疾
              <input
                id="cj5"
                type="checkbox"
                value="4,肢体残疾"
                name="hdsa000101.disabilitylist[4].hdsa00010106002"
                style="font-size: 16px;"
              />
              肢体残疾
              <input
                id="cj6"
                type="checkbox"
                value="5,智力残疾"
                name="hdsa000101.disabilitylist[5].hdsa00010106002"
                style="font-size: 16px;"
              />
              智力残疾
              <input
                id="cj7"
                type="checkbox"
                value="6,精神残疾"
                name="hdsa000101.disabilitylist[6].hdsa00010106002"
                style="font-size: 16px;"
              />
              精神残疾
              <input
                id="cj8"
                type="checkbox"
                value="7,其他残疾"
                name="hdsa000101.disabilitylist[7].hdsa00010106002"
                style="font-size: 16px;"
              />
              其他残疾

              <input
                id="hdsa000101046"
                type="text"
                readonly="readonly"
                value=""
                name="hdsa000101.hdsa000101046"
                cssclass="line"
                size="30"
                maxlength="50"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>

        <tr style="font-size: 16px;">
          <td colspan="2" align="center" height="30" style="font-size: 16px;">
            <span class="font_weight" style="font-size: 16px;"
              >与户主关系
              <font color="red" style="font-size: 16px;">*</font>
            </span>
          </td>
          <td colspan="10" style="font-size: 16px;">
            <span class="STYLE2" style="font-size: 16px;">
              <input
                id="relationshipToHead"
                type="hidden"
                name="relationshipToHead"
                value=""
                style="font-size: 16px;"
              />

              <input
                id="hdsa0001.hdsa0001022-1"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="0"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-1"
                class="checkboxLabel"
                style="font-size: 16px;"
                >本人</label
              >
              <input
                id="hdsa0001.hdsa0001022-2"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="1"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-2"
                class="checkboxLabel"
                style="font-size: 16px;"
                >配偶</label
              >
              <input
                id="hdsa0001.hdsa0001022-3"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="2"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-3"
                class="checkboxLabel"
                style="font-size: 16px;"
                >子</label
              >
              <input
                id="hdsa0001.hdsa0001022-4"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="3"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-4"
                class="checkboxLabel"
                style="font-size: 16px;"
                >女</label
              >
              <input
                id="hdsa0001.hdsa0001022-5"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="32"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-5"
                class="checkboxLabel"
                style="font-size: 16px;"
                >儿媳</label
              >
              <input
                id="hdsa0001.hdsa0001022-6"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="4"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-6"
                class="checkboxLabel"
                style="font-size: 16px;"
                >孙子、孙女或外孙子、外孙女</label
              >
              <input
                id="hdsa0001.hdsa0001022-7"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="5"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-7"
                class="checkboxLabel"
                style="font-size: 16px;"
                >父母</label
              >
              <input
                id="hdsa0001.hdsa0001022-8"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="6"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-8"
                class="checkboxLabel"
                style="font-size: 16px;"
                >祖父母或外祖父母</label
              >
              <input
                id="hdsa0001.hdsa0001022-9"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="7"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-9"
                class="checkboxLabel"
                style="font-size: 16px;"
                >兄弟姐妹</label
              >
              <input
                id="hdsa0001.hdsa0001022-10"
                type="checkbox"
                name="hdsa0001.hdsa0001022"
                value="8"
                checked="checked"
                class="validate[required]"
                style="font-size: 16px;"
              />
              <label
                for="hdsa0001.hdsa0001022-10"
                class="checkboxLabel"
                style="font-size: 16px;"
                >其他</label
              >

              <input
                id="hdsa0001023"
                type="text"
                readonly="readonly"
                value=""
                name="hdsa0001.hdsa0001023"
                cssclass="line"
                size="20"
                maxlength="50"
                style="font-size: 16px;"
              />
            </span>
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td rowspan="6" align="center" style="font-size: 16px;">生活环境</td>
        </tr>
        <tr style="font-size: 16px;">
          <td width="101" align="left" style="font-size: 16px;">
            厨房排风设施
          </td>
          <td colspan="10" style="font-size: 16px;">
            <input
              id="hdsa000201007"
              type="hidden"
              name="hdsa000201.hdsa000201007"
              value="无"
              style="font-size: 16px;"
            />

            <input
              id="hdsa000201.hdsa000201008-1"
              type="checkbox"
              name="hdsa000201.hdsa000201008"
              value="0"
              checked="checked"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201008-1"
              class="checkboxLabel"
              style="font-size: 16px;"
              >无</label
            >
            <input
              id="hdsa000201.hdsa000201008-2"
              type="checkbox"
              name="hdsa000201.hdsa000201008"
              value="1"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201008-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >油烟机</label
            >
            <input
              id="hdsa000201.hdsa000201008-3"
              type="checkbox"
              name="hdsa000201.hdsa000201008"
              value="2"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201008-3"
              class="checkboxLabel"
              style="font-size: 16px;"
              >换风扇</label
            >
            <input
              id="hdsa000201.hdsa000201008-4"
              type="checkbox"
              name="hdsa000201.hdsa000201008"
              value="3"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201008-4"
              class="checkboxLabel"
              style="font-size: 16px;"
              >烟囱</label
            >
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td align="left" style="font-size: 16px;">燃料类型</td>
          <td colspan="10" style="font-size: 16px;">
            <input
              id="hdsa000201003"
              type="hidden"
              name="hdsa000201.hdsa000201003"
              value="液化气"
              style="font-size: 16px;"
            />

            <input
              id="hdsa000201.hdsa000201006-1"
              type="checkbox"
              name="hdsa000201.hdsa000201006"
              value="0"
              checked="checked"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201006-1"
              class="checkboxLabel"
              style="font-size: 16px;"
              >液化气</label
            >
            <input
              id="hdsa000201.hdsa000201006-2"
              type="checkbox"
              name="hdsa000201.hdsa000201006"
              value="1"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201006-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >煤</label
            >
            <input
              id="hdsa000201.hdsa000201006-3"
              type="checkbox"
              name="hdsa000201.hdsa000201006"
              value="2"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201006-3"
              class="checkboxLabel"
              style="font-size: 16px;"
              >天然气</label
            >
            <input
              id="hdsa000201.hdsa000201006-4"
              type="checkbox"
              name="hdsa000201.hdsa000201006"
              value="3"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201006-4"
              class="checkboxLabel"
              style="font-size: 16px;"
              >沼气</label
            >
            <input
              id="hdsa000201.hdsa000201006-5"
              type="checkbox"
              name="hdsa000201.hdsa000201006"
              value="4"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201006-5"
              class="checkboxLabel"
              style="font-size: 16px;"
              >柴火</label
            >
            <input
              id="hdsa000201.hdsa000201006-6"
              type="checkbox"
              name="hdsa000201.hdsa000201006"
              value="5"
              disabled="disabled"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201006-6"
              class="checkboxLabel"
              style="font-size: 16px;"
              >其他</label
            >
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td align="left" style="font-size: 16px;">饮水</td>
          <td colspan="10" style="font-size: 16px;">
            <input
              id="hdsa000201001"
              type="hidden"
              name="hdsa000201.hdsa000201001"
              value="自来水"
              style="font-size: 16px;"
            />

            <input
              id="hdsa000201.hdsa000201002-1"
              type="checkbox"
              name="hdsa000201.hdsa000201002"
              value="0"
              checked="checked"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201002','hdsa000201.hdsa000201002','hdsa000201001')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201002-1"
              class="checkboxLabel"
              style="font-size: 16px;"
              >自来水</label
            >
            <input
              id="hdsa000201.hdsa000201002-2"
              type="checkbox"
              name="hdsa000201.hdsa000201002"
              value="1"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201002','hdsa000201.hdsa000201002','hdsa000201001')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201002-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >经净化过滤的水</label
            >
            <input
              id="hdsa000201.hdsa000201002-3"
              type="checkbox"
              name="hdsa000201.hdsa000201002"
              value="2"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201002','hdsa000201.hdsa000201002','hdsa000201001')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201002-3"
              class="checkboxLabel"
              style="font-size: 16px;"
              >井水</label
            >
            <input
              id="hdsa000201.hdsa000201002-4"
              type="checkbox"
              name="hdsa000201.hdsa000201002"
              value="3"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201002','hdsa000201.hdsa000201002','hdsa000201001')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201002-4"
              class="checkboxLabel"
              style="font-size: 16px;"
              >河湖水</label
            >
            <input
              id="hdsa000201.hdsa000201002-5"
              type="checkbox"
              name="hdsa000201.hdsa000201002"
              value="4"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201002','hdsa000201.hdsa000201002','hdsa000201001')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201002-5"
              class="checkboxLabel"
              style="font-size: 16px;"
              >塘水</label
            >
            <input
              id="hdsa000201.hdsa000201002-6"
              type="checkbox"
              name="hdsa000201.hdsa000201002"
              value="5"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201002','hdsa000201.hdsa000201002','hdsa000201001')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201002-6"
              class="checkboxLabel"
              style="font-size: 16px;"
              >其他</label
            >
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td align="left" style="font-size: 16px;">厕所</td>
          <td colspan="10" style="font-size: 16px;">
            <input
              id="hdsa000201005"
              type="hidden"
              name="hdsa000201.hdsa000201005"
              value="卫生厕所"
              style="font-size: 16px;"
            />

            <input
              id="hdsa000201.hdsa000201004-1"
              type="checkbox"
              name="hdsa000201.hdsa000201004"
              value="0"
              checked="checked"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201004','hdsa000201.hdsa000201004','hdsa000201005')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201004-1"
              class="checkboxLabel"
              style="font-size: 16px;"
              >卫生厕所</label
            >
            <input
              id="hdsa000201.hdsa000201004-2"
              type="checkbox"
              name="hdsa000201.hdsa000201004"
              value="1"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201004','hdsa000201.hdsa000201004','hdsa000201005')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201004-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >一格或二格粪池式</label
            >
            <input
              id="hdsa000201.hdsa000201004-3"
              type="checkbox"
              name="hdsa000201.hdsa000201004"
              value="2"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201004','hdsa000201.hdsa000201004','hdsa000201005')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201004-3"
              class="checkboxLabel"
              style="font-size: 16px;"
              >马桶</label
            >
            <input
              id="hdsa000201.hdsa000201004-4"
              type="checkbox"
              name="hdsa000201.hdsa000201004"
              value="3"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201004','hdsa000201.hdsa000201004','hdsa000201005')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201004-4"
              class="checkboxLabel"
              style="font-size: 16px;"
              >露天粪坑</label
            >
            <input
              id="hdsa000201.hdsa000201004-5"
              type="checkbox"
              name="hdsa000201.hdsa000201004"
              value="4"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201004','hdsa000201.hdsa000201004','hdsa000201005')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201004-5"
              class="checkboxLabel"
              style="font-size: 16px;"
              >简易棚厕</label
            >
          </td>
        </tr>
        <tr style="font-size: 16px;">
          <td align="left" style="font-size: 16px;">禽畜栏</td>
          <td colspan="10" style="font-size: 16px;">
            <input
              id="hdsa000201009"
              type="hidden"
              name="hdsa000201.hdsa000201009"
              value="无"
              style="font-size: 16px;"
            />

            <input
              id="hdsa000201.hdsa000201010-1"
              type="checkbox"
              name="hdsa000201.hdsa000201010"
              value="0"
              checked="checked"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201010','hdsa000201.hdsa000201010','hdsa000201009')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201010-1"
              class="checkboxLabel"
              style="font-size: 16px;"
              >无</label
            >
            <input
              id="hdsa000201.hdsa000201010-2"
              type="checkbox"
              name="hdsa000201.hdsa000201010"
              value="1"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201010','hdsa000201.hdsa000201010','hdsa000201009')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201010-2"
              class="checkboxLabel"
              style="font-size: 16px;"
              >单设</label
            >
            <input
              id="hdsa000201.hdsa000201010-3"
              type="checkbox"
              name="hdsa000201.hdsa000201010"
              value="2"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201010','hdsa000201.hdsa000201010','hdsa000201009')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201010-3"
              class="checkboxLabel"
              style="font-size: 16px;"
              >室内</label
            >
            <input
              id="hdsa000201.hdsa000201010-4"
              type="checkbox"
              name="hdsa000201.hdsa000201010"
              value="3"
              disabled="disabled"
              onclick="checkedThis(this,'hdsa000201.hdsa000201010','hdsa000201.hdsa000201010','hdsa000201009')"
              style="font-size: 16px;"
            />
            <label
              for="hdsa000201.hdsa000201010-4"
              class="checkboxLabel"
              style="font-size: 16px;"
              >室外</label
            >
          </td>
        </tr>
      </tbody>
    </table>
    <span slot="footer" class="dialog-footer">
      <el-button @click="isShow = false">取 消</el-button>
      <el-button type="primary" @click="isShow = false">确 定</el-button>
    </span>
  </el-dialog>
</template>
<script>
export default {
  data() {
    return {
      birthdata: "", // 出生日期
      // 弹框的显示隐藏
      isShow: false
    }
  },
  props: {
    dialogVisible: {
      type: Boolean,
      default: false
    },
    title: {
      type: String,
      title: ""
    }
  },
  watch: {
    dialogVisible(newValue, oldValue) {
      // console.log(newValue)
      this.isShow = newValue
    }
  },
  methods: {
    // 重置表单

    handleClose() {
      // 关闭窗口
      this.isShow = false
      this.$emit("update:dialogVisible", false)
    },
    handleAdd() {}
  }
}
</script>
<style lang="scss" scoped>
table {
  table-layout: fixed;
}
</style>
